Getting patients comfortable with telehealth

Before there can be patient-generated data, there have to be patients willing and able to provide it and tools to capture, communicate, receive and present it. That's where Dr. Susan Woods comes in.

“My focus is really on the patient's and the caregiver's use of electronic tools and on making value for patients in using these tools,” said Woods, who is the director of patient experience for the Veterans Health Administration.

“Ultimately, the goal is the patient will enter information they choose to share with their clinician team, either on the Internet, a smartphone or at a clinic on a tablet, and we'll have sharing of that information across different platforms,” she said. “If they send information on the Internet portal, they'll be able to see it and share it on another device.”

The VA demonstrated many of its patient connection wares at a media briefing Tuesday at the National Press Club, headlined by Dr. Robert Petzel, the VA's undersecretary for health, and U.S. Sen. Bernie Sanders, I-Vt., who chairs the Senate Veterans Affairs Committee.

Sanders, in a written statement about the VA presentation , lauded telehealth, one of the technologies in the VA health IT armamentarium demonstrated that day, saying it “significantly improves access to healthcare, especially in rural areas, like my home state of Vermont.”

“Telehealth knocks down one of the barriers to treatment by bringing care to the veteran, rather than the veteran having to travel for care,” Sanders said. “Doctors and nurses can literally keep tabs on the daily progress of their patients without the need for an office visit. This is proving to be very effective, from both the clinical and cost perspective, while giving veterans some peace of mind.”

Other patient connection technologies developed by the VA and demonstrated this week were its popular MyHealtheVet patient portal, its homegrown Blue Button download system, and a raft of new mobile apps.

MyHealtheVet, launched a decade ago, now has 1.2 million “authenticated” VA patients who have full access to its features, including Blue Button, a VA-developed technology that enables patients to make electronic copies of their medical records. HHS and other units of the federal government have since embraced Blue Button and are promoting it as a way to achieve patient-centric interoperability in the private sector.

“That data is the patient's data,” Woods said. “They currently can go back and see it.” But the challenge for the VA, and the nation, is getting patient-entered data in front of clinicians in a useful, actionable form and in the right place in their workflow. At the VA, “it's not automatically shared with the patient team. There is secure messaging, for example, and that's part of our clinical information system, we can save it as notes. When patients order medications, that comes into our system. But if they're entering blood pressure, for example, they have to print that out, it's not automatically shared.

“So, our mobile apps are really the next generation of tools,” Woods said. The VA is now running a pilot program with 1,000 tablet computers distributed to veterans and preloaded with a selection of new, VA-developed mobile healthcare apps.

One will enable veterans to request appointments via the tablet. Another is a journal for caregivers to help them deal with the stress of providing care for a wounded, disabled or ill veteran. There is a communications tool for caregivers to connect with clinicians and other help at the VA. In addition, there's one that focuses on pain, to support both the patient and the caregiver.

“People agreed to tell us about their use and we're monitoring their use,” Woods said. “We'll have some phenomenal input from the users themselves.”

Another opportunity to use mobile or hard-wired computers for receiving patient-entered data is when the patients are at VA hospitals or clinics, Woods said. “That's really important because not everybody has a smartphone or a laptop,” she said. “We want to make sure everybody has access to the same kinds of tools and information. So, we've rolled out the beginning of that, which is our kiosk program.” That consists of computers at the VA points of care where patients can enter data the same way as those who have PCs at home.

“The goal is having more and more functionality at the point of care,” Woods said. At the Portland, Ore., VA Medical Center where Woods works, patients can use a computer to review their medication lists and enter other medications they are taking that aren't on the VA's list.

“It's a very cool program,” Woods said. “Each medication is presented to the patient, one by one, including a picture of the medication. We're asking the patient, 'Are you taking this as prescribed?' I can bring that information into my clinical note.”

Woods said research has shown that patients are often more open and honest providing information via computer than directly to a clinician, particularly about sensitive information in their own or their families' medical histories. Plus, patient-supplied data, in some cases, are better data than what can be obtained in a clinic or hospital.

For a patient with hypertension, for example, “It's very important to monitor your blood pressure when you're at home, hanging around, or out on the town,” Woods said. “I'd say most physicians want that data, instead of twice a year in their office.” For clinicians, the challenge is, how to get that into EHRs in a usable place and format. “That's where we have to get really smart with our digital tools. It has to be tagged and has to be right up there next to the list of performance reminders.”

How long before electronic, patient-entered data are commonplace? “We're not there yet, but that's the goal. That's the prize,” Woods said.